The release of the “Better Care Reconciliation Act” last week was followed by a predictable flood of media stories and commentary decrying the proposed changes to Medicaid. In some ways, it echoed arguments used during the welfare reform debate in the 1990’s.

Yet the health care outrage lacked basic context and often contained misleading statements or outright falsehoods. While the bill is far from perfect and needs some significant changes, a reality-based foundation is imperative for meaningful discourse to occur.

False claim: TheMedicaid “cuts” are huge

Reality: Only in government does slowing the growth of spending mean “cuts”

For decades in the health policy community most have agreed a good first step would be to slow the rate of growth, but in a partisan environment, that becomes “mean and heartless.”

During the 2012 campaign, while debate was swirling around Obamacare’s payment reductions in Medicare, PolitiFact wrotethat “While the health care law reduces the amount of future spending growth in Medicare, the law doesn't actually cut Medicare.”

Surely ACA supporters aren’t using this logic for partisan or ideological reasons?

Ultimately, Obamacare supporters can’t have it both ways, defending $716 billion in Medicare payment reductions as inconsequential in the ACA while claiming a similar reduction in Medicaid will cause the sky to fall.

A demonstrator protesting cuts to Medicaid is carried away from the office of Senate Majority Leader Mitch McConnell by U.S. Capitol police officers (Photo: Andrew Harrer/Bloomberg)

False claim: Growing costs are the main problem & per capita cap funding will not be enough

Reality: Enrollment growth is driving spending increases and per capita caps are a good first step towards reform

When the Congressional Budget Office (CBO) scored these bills,the projected savings from changes in Medicaid were almost entirely related to Medicaid enrollment changes-- not capping the program. In fact, analysis by my colleague Jonathan Ingram at the Foundation for Government Accountability has shown that, historically, almost all states would not have exceeded the caps set in the House bill. Just 0.4 percent of spending would have exceeded the cap.

Actually, the caps are projected to grow at a higher rate than projected spending for seniors and the disabled. (4.8% projected for 2019 and beyond vs. 4.6%)

Altogether, if the caps had been in place starting in 2000, actual spending growth would have remained lower than the targets set by BCRA.

So the draconian claims of seniors being thrown out of nursing homes or the disabled being targeted for cuts are farfetched. Skyrocketing enrollment is responsible for the vast majority of Medicaid spending increases. Any meaningful effort to improve the program’s sustainability must work to transition more individuals to private coverage.